BACKGROUND: Patients who are born without spleen or who have impaired splenic function due to disease or splenectomy become vulnerable to sepsis caused by bacteria. Overwhelming post-splenectomy infection (OPSI) occurs at an estimated incidence of 0.23-0.42% per year with a lifetime risk of 5%. The risk of OPSI with encapsulated bacteria is generally considered greatest in the first 2 years after splenectomy but the increased risk remains lifelong. Because vaccination doesn't completely protect against infection with encapsulated bacteria that prevent OPSI, use of prophylactic antibiotics are recommended for prevention of infection after splenectomy.METHODS: A retrospective review of 41 patients who underwent splenectomy from January 1990 to December 2012 in Inje University Busan Paik Hospital were identified through the medical records.RESULTS: Of 41 patients, 100% (41/41) were vaccinated in pneumococcal vaccines, 27% (11/41) were vaccinated in HIB vaccines. Prophylactic antibiotics (penicillin G benzathine IM every 4 weeks) were prescribed in 73% (30/41) of patients. We could not find any septic events.CONCLUSION: Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. Prophylactic antibiotics using Penicillin G benzathine every 4 weeks is effective for preventing septic events in splenectomized patients. But further improvement in coverage of recommended vaccines and continuous prophylactic antibiotics after splenectomy is needed to reduce the risk of serious infection.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Bacteria ; Ethylenediamines ; Haemophilus influenzae type b ; Humans ; Incidence ; Medical Records ; Mortality ; Penicillin G Benzathine ; Pneumococcal Vaccines ; Retrospective Studies ; Sepsis ; Spleen ; Splenectomy ; Vaccination ; Vaccines

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics.METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course.RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms.CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.
Chronic Disease ; Edema ; Emergencies ; Gastrointestinal Hemorrhage ; Hemophilia A ; Hemophilia B ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Joints ; Lower Extremity ; Muscles ; Overall ; Retrospective Studies ; Seizures

Ameloblastomaa are odontogenic benign tumors with epithelial origin, which are characterized by slow, aggressive, and invasive growth. Most ameloblastomas occur in the mandible, and their prevalence in the maxilla is low. A 27-year-old male visited our clinic with a chief complaint of the left side nasal airway obstruction. Three-dimensional computed tomography showed left maxillary sinus filled with a mass. Except for the perforated maxillary left edentulous area, no invaded or destructed bone was noted. The tumor was excised via Le Fort I osteotomy. The main mass was then sent for biopsy and it revealed acanthomatous ameloblastoma. The lesion in the left maxillary sinus reached the ethmoidal sinus through the nasal cavity but did not invade the orbit and skull base. The tumor was accessed through a Le Fort I downfracture in consideration of the growth pattern and range of invasion. The operation site healed without aesthetic appearances and functional impairments. However, further long-term clinical observation is necessary in the future for the recurrence of ameloblastoma. Conservative surgical treatment could be the first choice considering fast recovery after surgery and the patient's life quality.
Adult ; Ameloblastoma ; Biopsy ; Humans ; Male ; Mandible ; Maxilla ; Maxillary Sinus ; Nasal Cavity ; Nasal Obstruction ; Orbit ; Osteotomy ; Prevalence ; Quality of Life ; Recurrence ; Skull Base

BACKGROUND: Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. CASE PRESENTATION: This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. CONCLUSIONS: In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.
Anesthesia, General ; Cicatrix ; Connective Tissue ; Facial Asymmetry ; Facial Bones ; Fibrous Dysplasia, Monostotic ; Follow-Up Studies ; Humans ; Maxilla ; Photography ; Recurrence