No abstract available.
Humans ; Jehovah's Witnesses

Aortopulrnonary window is an uncommon cardiac anomaly accounting for approximately 0.2-0.6% of all congenital cardiac anomalies in which there is a connection between the ascending aorta and pulmonary trunk. Since the first report of successful surgical repair, many investigators have advocated surgical closure of all types of aortopulmonary windows using different technique. The majority of aortopulmonary windows require surgical therapy due to extensive size or location. A few cases of interventional closure of APW with double umbrella and buttoned device are reported, but Gianturco coil has not been used previously. A case is described in an infant with a small aortopulmonary window which was closed by Gianturco coil after APW banding. He did not receive corrective operation because his parents who are Jehovahs Witnesses refused transfusion. Complete occlusion of the defect was achieved without complications. Transcatheter coil closure of a small aortopulmonary window is feasible in infancy and the technique is likely to be applicable in a few cases.
Aorta ; Humans ; Infant ; Jehovah's Witnesses ; Parents ; Research Personnel

PURPOSE: In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. MATERIALS AND METHODS: We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. RESULTS: Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. CONCLUSIONS: Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.
Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Erythropoietin* ; Humans ; Jehovah's Witnesses ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms* ; Retrospective Studies

Jehovah's Witnesses refuse a transfusion of blood or blood products because of religious beliefs; this refusal at times presents a dilemma for the treating physician. We report a case of a 25-year-old Jehovah's Witness patient who underwent a reoperation for a previous proximal humerus shaft fracture and experienced unexpected massive hemorrhage intraoperatively and postoperatively. The postoperative lowest hemoglobin level was 2.9 g/dl. The patient recovered from the severe anemia without any clinical sequala. We review the legal, ethical and religious issues and suggest the best possible medical care that Jehovah's Witness patient would permit.
Adult ; Anemia ; Anesthesia* ; Disulfiram ; Hemorrhage* ; Humans ; Humerus ; Jehovah's Witnesses ; Religion ; Reoperation

Jehovah's Witnesses refuse the transfusion of blood and blood products, even when it can be lifesaving. Their religious conviction against receiving blood can create a difficult clinical dilemma, particularly in the life threatening situations. We report a case of a 42-year-old female Jehovah's Witness patient who had life-threatening anemia after postpartum hemorrhage. Despite severe anemia, she had a good postoperative recovery without complications.
Adult ; Anemia ; Blood Transfusion ; Female ; Humans ; Jehovah's Witnesses ; Postpartum Hemorrhage ; Ventilators, Mechanical ; Wit and Humor as Topic

BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Adult ; Blood Transfusion ; Bloodless Medical and Surgical Procedures* ; Heart Valves* ; Humans ; Jehovah's Witnesses* ; Mortality ; Perioperative Care ; Survival Rate

The conversion of failing Fontan circuit to total cavopulmonary connection(TCPC) is recommended as a therapeutic option in patients with late Fontan complications such as atrial arrhythmia, atrial enlargement, pulmonary venous obstruction, and ventricular dysfunction. Combined TCPC with extracardiac conduit and cryoablation of arrhythmia circuit is preferred for treatment of failing Fontan connection with atrial tachyarrhythmia. We report a case of conversion of atriopulmonary connection to extracardiac conduit Fontan and cryoablation of atrial arrhythmia circuit in a patient with tricuspid atresia, who also had ectopic atrial tachycardia, right atrial thrombi, pulmonary venous obstruction, and ventricular dysfunction. This patient and the parents were Jehovah's Witnesses; therefore, the patient underwent the procedure without blood transfusion.
Arrhythmias, Cardiac* ; Blood Transfusion ; Cryosurgery ; Humans ; Jehovah's Witnesses* ; Parents ; Tachycardia ; Tachycardia, Ectopic Atrial ; Tricuspid Atresia ; Ventricular Dysfunction

Liver transplantation is especially challenging in patients who are Jehovah's Witnesses because their religious beliefs prohibit the receipt of blood products. We present two cases of living donor liver transplantation performed in adult Jehovah's Witnesses in South Korea without the use of blood products. In the first case, preoperative erythropoiesisstimulation therapy increased hemoglobin levels from 8.1 to 13.1 g/dl after 9 weeks. In the second case, hemoglobin levels increased from 7.4 to 10.8 g/dl after 6 months of erythropoiesis-stimulation therapy. With the combination of acute normovolemic hemodilution, intraoperative cell salvage, and use of transfusion alternatives, liver transplantation was successfully performed without transfusion of blood products.
Adult ; Bloodless Medical and Surgical Procedures ; Hemodilution ; Humans ; Jehovah's Witnesses* ; Korea ; Liver Transplantation* ; Liver* ; Living Donors ; Operative Blood Salvage ; Religion

Jehovah's Witnesses are widely known for their prohibition for accepting blood transfusion. Because of the firm refusal to receive transfused blood and blood components by Jehovah's Witnesses, the management of Jehovah's Witness patients with severe bleeding is often complicated by medical, ethical and legal concerns. We report here on two cases of successful treatment of Jehovah's Witnesses who underwent total hip replacement for secondary osteoarthritis and Chiari osteotomy for acetabular dysplasia.
Arthroplasty, Replacement, Hip ; Blood Transfusion ; Disulfiram ; Hemorrhage ; Hip ; Hip Joint ; Humans ; Jehovah's Witnesses ; Osteoarthritis ; Osteotomy ; Wit and Humor as Topic

BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Adult ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Heart Valves ; Humans ; Jehovah's Witnesses ; Mortality ; Perioperative Care ; Survival Rate