1/4. role of autologous blood transfusion in sacral tumor resection: patient selection and recovery after surgery and blood donation.We carried out sacral en-bloc resection in six patients (three with chordoma; one with pheochromocytoma; one with malignant schwannoma; and one with giant cell tumor) using preoperatively collected autologous blood, to avoid homologous blood transfusion. An average of 3200 ml was collected preoperatively, with patients receiving recombinant human erythropoietin (r-HuEPO), at a total dose of 130 000 units on average. In four patients, we were able to accomplish the surgery without homologous blood transfusion. Postoperatively, the hemoglobin level in these four patients recovered to the pre-collective level in 4.5 weeks, on average. These clinical results indicate that en-bloc sacrectomy, which requires a large volume of blood transfusion, can be accomplished with preoperatively collected autologous blood alone.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/4. Autologous cord blood transfusion in an infant with a huge sacrococcygeal teratoma.We describe a case of cord blood harvest for autologous transfusion in a neonate weighing 3,992 g with a giant sacrococcygeal teratoma. The umbilical vein was pierced with an 18-gauge needle, and placental blood was withdrawn into two 50-ml syringes filled with 4 ml of citrate-phosphate-dextrose solution. Resection of the sacrococcygeal teratoma was performed on day one. During the operation the infant lost 46 ml of whole blood, more than 15% of the estimated total blood volume, and thus underwent autologous transfusion with 27.8 ml of packed red cells obtained from autologous cord blood. Consequently, she could avoid homologous blood transfusion during the hospital stay. This case highlights the safety of this procedure, with no evidence of consumption coagulopathy, hemolysis or bacterial infection.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/4. Use of preoperative autologous blood donations and erythropoietin for treatment of giant cell tumor of the ischium.A 24-year-old man with an osteolytic lesion of the ischium was referred to the authors' institution. Computed tomography and magnetic resonance imaging studies showed that the lesion extended to and involved the subchondral bone of the acetabulum. Histologic examination of the biopsy specimen revealed giant cell tumor of bone. Following the biopsy, autologous blood was collected 4 times with recombinant human erythropoietin treatment definitive surgery was performed. Three weeks after the biopsy, the lesion was curetted and bone cementation was performed. The total blood loss during surgery was 3100 ml, which was replaced successfully with stored autologous blood without the need for homologous blood transfusion. The authors believe that without the erythropoietin treatment, autologous blood could have been collected only 3 times instead of 4 times, and the patient would have needed homologous blood.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
4/4. laparoscopy for adult polycystic kidney disease: a promising alternative.The purpose of this study was to evaluate the efficacy of laparoscopy in managing patients with abdominal symptoms from autosomal dominant polycystic kidney disease (ADPKD). From April 1993 to July 1995, four patients with ADPKD underwent seven laparoscopic procedures: five cyst decortications were performed in two patients using a laparoscopic ultrasound unit and two laparoscopic nephrectomies were performed in two patients with end-stage renal failure. The mean operative time was 207 minutes for laparoscopic cyst decortication and 272 minutes for laparoscopic nephrectomy. The two nephrectomy specimens were 2,200 g and 1,750 g, respectively. The mean intraoperative blood loss was 85 mL. The patients resumed their oral intake within 10 hours after laparoscopic cyst decortication and within 16 hours after laparoscopic nephrectomy. The mean amount of parenteral analgesics required postoperatively was 12 mg morphine sulfate for cyst decortication and 30 mg morphine sulfate for nephrectomy. The mean hospital stay was 3 days for cyst decortication and 3.5 days for nephrectomy. The patients returned to their usual activities after an average of 2 weeks. Based on pain analog scales, all the patients have shown marked reduction in their symptoms (average, 90%) during an average follow-up period of 6.6 months. Laparoscopic cyst decortication and nephrectomy are effective minimally invasive treatment options for patients with adult polycystic kidney disease who are experiencing abdominal symptoms due to marked renal enlargement. We believe that by using a laparoscopic ultrasound unit, most renal cysts may be safely removed, and if need be, even "giant" kidneys can be removed laparoscopically. To the best of our knowledge, the two nephrectomy specimens in this study represent the largest kidneys removed laparoscopically to date and the first laparoscopic nephrectomies in ADPKD patients.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |