Background: Alcoholic liver disease (ALD) includes a wide clinical spectrum from acute alcoholic hepatitis to severe cirrhosis and/or hepatocellular carcinoma. Until now, there has been no report revealing the bleeding tendency of ALD compared to other diseases in liver transplantation (LT). Thus, we analyzed blood loss and transfusion amounts during operation according to the etiologies of liver disease and model for end-stage liver disease (MELD) score. Methods: Out of 874 recipients who underwent LT, a total of 146 patients were excluded by our exclusion criteria. We compared 728 recipients’ baseline characteristics, operation time, blood loss, and transfusion amounts between ALD and nonALD according to MELD score. Results: The number of patients in the ALD group was 130 (17.9%), and 598 (82.1%) in the non-ALD group. The ALD group showed younger age, higher MELD score, and a higher proportion of deceased donor LT than the non-ALD group. Intraoperative blood loss and transfusions of red blood cells (RBCs), fresh frozen plasma, and platelets were significantly higher in the ALD group. When stratified by MELD score (cut-off: 20), ALD patients in both high and low MELD subgroups demonstrated greater blood loss and RBC transfusion requirements, even when international normalized ratio and platelet counts were similar. In multivariate logistic regression analysis, ALD was a significant risk factor for massive transfusion (odds ratio 1.813, 95% confidence interval 1.158–2.840, p=0.009). Conclusion The ALD group showed increased bleeding tendency than the non-ALD group during LT, irrespective of MELD score. This suggests that transplant surgeons should anticipate greater blood loss and ensure adequate transfusion resources during LT for ALD patients.

For women with a BRCA 1/2 mutation, prophylactic bilateral salpingo-oophorectomy (BSO) is known to reduce the risk of developing both ovarian and breast cancer. The increasing interest in hereditary breast cancer has recently resulted in frequent genetic testing for high-risk patients. Since breast surgeons frequently encounter BRCA-positive breast cancer patients or carriers in the outpatient clinic, it is a prerequisite that the decision of the patients and doctors should be based on a thorough understanding of the objective risk, the medical assessment and the various treatment options, including surgery and anti-cancer therapy. The risk for the ovarian cancer also makes up an important part of genetic counseling; therefore, the breast surgeons should be well aware of this. This report presents the first experience with performing single-port access laparoscopic prophylactic BSO for a BRCA-positive breast cancer patient, and this procedure was technically feasible and the patient had minimal scar. However, a future investigation is needed to properly assess the cosmetic outcome in this approach.
Ambulatory Care Facilities ; Breast ; Breast Neoplasms ; Cicatrix ; Cosmetics ; Female ; Genetic Testing ; Humans ; Laparoscopy ; Ovarian Neoplasms

Surgeons have been dependent mainly on the clinical findings in the diagnosis of the empyema of gallbladderrequiring a emergent surgical intervention. Ultrasonographic findings of empyema of gallbladder are similar tothose of acute cholecystitis, but several finding are more frequently seen in empyema than in acute cholecystitis.We reviewed the clinical and ultrasonographic pictures in 15 cases of surgically proven empyema of gallbladder.The results were as follows: 1. Empyema of GB shows relatively high frequency in male and elderly person, comparedwith acute cholecystitis. 2. Right upper abdominal pain with tenderness and leukocytosis are constant findings inempyema. 3. Ultrasonographic findings; (1) GB is distended in 80%. (2) GB wall is thickened all ill defined in80%. (3) Internal echo is seen in 93.3%-diffuse(53.3%), localized (20%) or layered(20%). (4) Gallstones arelocated in CBD causing dilatation proximally.
Abdominal Pain ; Aged ; Cholecystitis, Acute ; Diagnosis ; Dilatation ; Empyema ; Gallbladder ; Gallstones ; Humans ; Leukocytosis ; Male ; Surgeons

Two cases of skull metastasis from thyroid carcinoma are presented. The one case shows multiple involvement inthe skull base with sphenoid sinus, frontal bone, and rib. The other case is solitary extensive involvement to theright parietal bone. The follicular caroinoma of the thyroid shows a strong tendency toward vascualr invasion and dissemination through blood stream to the lungs, bones, liver, brain, and other distant sites. The sternum, thevetebrae, and the pelvis are the most common sites in bone metastasis of thyroid carcinoma, followed by the femur,shoulder girdle, skull, and rib. Metastatic caroinoma to the skull base, including sphenoid sinus s extremelyrare. Authors experienced recently 2 cases of metastatic carcinoma of the thyroid to the skull and report withreview of literature.
Brain ; Frontal Bone ; Liver ; Lung ; Neoplasm Metastasis ; Parietal Bone ; Pelvis ; Ribs ; Rivers ; Skull Base ; Skull ; Sphenoid Sinus ; Sternum ; Thyroid Gland ; Thyroid Neoplasms