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

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

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

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.
Abscess ; Aorta ; Aorta, Thoracic ; Brachiocephalic Trunk ; Carotid Artery, Common ; Chills ; Drainage ; Elephants ; Esophagus ; Fever ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Subclavian Artery ; Transplants*

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

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

Nowadays, plastic surgical operations are increasingly being performed in Korea. We have gained added interest in this because some professional pictures contain plastic surgery in their venue. In the films, we intend to see the recognition of society for plastic surgeons and which field of plastic surgery. The list of movies for analysis were 'Plastic Beauty (1975)', 'Penthouse Elephant (2005)', '200 Pounds Beauty (2006)', 'Cinderella (2006)', and 'Time (2006)'. The TV dramas were 'She is looking (2005)', 'Lovers (2006-2007)', and 'Before & After Plastic Surgery Clinic (2008)'. Films were analyzed according to the following: the chief complaints and names of the operations, character of plastic surgeons, result of the operation and its possibility in reality, and its effect of plastic surgery on the life of the patients. Most of the film contained facial transplantation or the change of the face or body different from the original shape. Character type of the plastic surgeons was mostly medical realism, rather than ideal humanism. Most of the plastic surgeons have capability as a doctor; however, some of them had extramarital affairs. The surgery was successful in most of the cases, but were the patients happy with the results? This was not the case in the movies. In only one movie, '200 Pounds Beauty', the patient became happy; rest of them were eminently unhappy with the outcome. Why the discrepancy? It is difficult to analyze the minds of the people in the films, but considering that the majority of the characters in the films were rather unsavory, one may deduce that a crooked mind functions differently. Perhaps it is too much to hope for a day that will come when we will see a film that portrays the mental anguish that accompanies each and every procedure the Korean plastic surgeons make.
Beauty ; Body Image ; Drama ; Elephants ; Facial Transplantation ; Humanism ; Humans ; Korea ; Motion Pictures as Topic ; Stress, Psychological ; Surgery, Plastic

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

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