Essential Pharmaceuticals

HCG performs the first auto liver transplantation in Karnataka

editor — Mon, 14 May 2012 14:14:04 +0000

BANGALORE, KARNATAKA, INDIA

HealthCare Global Enterprises Ltd, The Specialist in Cancer
Care, performed the first auto liver transplantation ( Ex Vivo liver resection)
in Karnataka.

Thimme Gowda, 64 year old patient, from Bangalore, was
diagnosed 3 weeks ago with Hepato Cellular Carcinoma, at a private hospital in
the city. His condition was critical and was referred to HCG from another
oncologist for a second opinion.

Dr. Sanjay Govil, Liver Transplant
Surgeon, HCG, said, “Initially the patient had began to notice a feeling of
abdominal fullness and loss of appetite since April 2012. He first went to
another private hospital in the city and an ultra sound scan detected large
tumor in the liver, in the size of a large melon that was in the centre of his
liver. The tumor was awkwardly situated at a site where it partially obstructed
all three Hepatic veins that carried blood out of the liver towards the heart.
Any attempt at trying to remove the tumour by standard surgery would result in
profuse bleeding from these veins that were likely to be injured while removing
the tumour. The other oncologist was kind enough to seek a second opinion from
the specialist and refer the patient.”

He further adds. “We analyzed the
case in detail. The procedure adopted was to remove the liver from the patient’s
body so that we could wash it in a preservative solution (HTK solution) and keep
it in ice so that the liver could survive a number of hours without blood flow.
We therefore chose this approach – called ‘Ex-vivo’ resection – literally
meaning ‘out of body’- also called ‘Bench Surgery’ (because it is done on the
bench next to the patient) and ‘Auto-transplantation’ – meaning that the
patient’s own healthy liver is transplanted back into his body. We were able to
perform the operation safely with very little blood transfusion. The patients
liver function is very good postoperatively and he is recovering slowly. Ex
–Vivo resection is performed in the specific instance where the tumour involves
either the veins draining the liver or the main vein draining blood back to the
heart – where considerable blood loss is anticipated. This case highlights not
only a rare and unusual operation, but also the importance of referral to
specialists before denying treatment to someone and the importance of patients
getting a second opinion for major illnesses.

About HCG

Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer
Care, headquartered in Bangalore with over 25 cancer centers is South Asia’s
largest cancer care network. HCG has defined the future of cancer care in India
by designing, building and managing cancer care centres with a committed vision.
HCG focuses on cancer care treatment, imaging and laboratory services, clinical
trials and research services. The vision of HCG is to make high quality cancer
care accessible by adopting global innovations to all segments of the society

Essential Pharmaceuticals proudly sponsors “Shore Dreams for Kids”

editor — Thu, 10 May 2012 14:09:16 +0000

We came across this worthy Charity from a dear friend. We salute all those that work so hard to make ”shore dreams” come true for children up against daily battles.

www.shoredreamsforkids.org

Vascular Ring Connector for Open Surgery in Type A Aortic Dissection – Custodiol used for Cardioplegia

editor — Tue, 08 May 2012 15:48:57 +0000

http://www.youtube.com/watch?v=KC8hZOm6mfE

Operator: Jeng Wei, MD, MSD, Director of Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
This case is considered to be very complicate and almost always fatal during surgery. The intimal tear was not found in the ascending aorta and aortic arch and was possibly located at the descending thoracic aorta, with the dissection flap extended to the ascending aorta. Conventional open reconstruction for the long segment of aorta is almost impossible since suturing technique usually results in uncontrollable bleeding. Stent graft is also impossible because there was no healthy portion of aorta for carotid bypass. With the use of vascular ring connector (VRC, Vasoring), the operation might be carried out without much difficulty. This film showed how we use four VRC to reconstruct the ascending aorta, aortic arch, and upper portion of the descending aorta with Dacron grafts. The sequence of the procedure is important: 1. left carotid bypass at the neck with 6-8 mm graft, then CPB through femoral artery and right subclavian artery, 2. Stop femoral circulation, keep cerebral perfusion only, 3. small incision on the ascending aorta for examination and searching the intimal tear, 4. If no tear was found in the ascending aorta, then extend the incision to aortic arch and insert a ringed graft into the aortic root, then fix the VRC with tapes, then give cardioplegia (preferably HTK for it may last longer), 5. search the intimal tear again, if it is not in the arch, then use 10-15 cm elephant trunk to repair the upper portion of descending aorta. The ring shoud be placed at the distal arch, 6. innominate artery bypass with a 10-12 mm ringed graft though the aortotomy, then anastomose it to the aorta. The graft should be very short, usually 1-2 cm long, 7. anastomose the left carotid bypass graft to the aorta, 8. use a ring (telescope type) or suture technique to anastomose the arch graft and the aortic root graft.
Please note that the aortic root graft should be clamped after giving cardioplegia throughout the whole procedure so that air won’t get into the heart chamber, thus there is no need to take more time to remove air from the heart. The left subclavian artery can be safely ligated in most cases, but if the mean arterial BP over the left radial artery is lower than 60, carotid-subclavian bypass might be needed.
With this technique, most patients need no blood transfusion and may recover well soon after the surgery.

Latest winner of Kindle Fire Announced!

editor — Fri, 04 May 2012 14:01:26 +0000

Dr. Richard Perez is the latest winner of a Kindle Fire. We give one of these away every two months by a random drawing from the names of those subscribed to our “e-news”. What are you waiting for? Get the latest organ preservation solution transplant news, human interest stories, info on upcoming meetings and enter to win a Kindle Fire – it’s as simple as that.

We love Facebook!!!

editor — Thu, 03 May 2012 16:54:48 +0000

http://www.usatoday.com/news/health/story/2012-05-01/Facebook-organ-donation-feature/54671522/1

The organ donation community is applauding Facebook’s announcement Tuesday that it will allow its 900 million members to share their donor status with friends and family, and to link to state databases where people in the USA can register online to officially become donors.

Organ Donation promoted by Facebook

editor — Tue, 01 May 2012 17:11:40 +0000

http://www.nytimes.com/2012/05/01/technology/facebook-urges-members-to-add-organ-donor-status.html?pagewanted=all

What are your feelings about this?

Viaspan shortage continues

editor — Tue, 24 Apr 2012 14:28:36 +0000

In light of the recent global recall of Viaspan, Essential Pharmaceuticals wants
to ensure the transplant community that we are able to meet all current and new
customer demands. Having already supplied new customers needing a replacement
organ preservation solution, Essential is committed to ensuring Custodiol
production and availability will meet your organ preservation solution needs

http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=907

FDA reports current drug Shortage of Sodium Bicarbonate Injection

editor — Fri, 20 Apr 2012 14:18:13 +0000

and the American Society of Health System Pharmacists confirm that there is a shortage until at least early June.

Sodium Bicarbonate is used when blood is the cardioplegia choice. Custodiol HTK requires no Sodium Bicaronate…an excellent choice!!

Sodium Bicarbonate Injection

Products Affected – Description

Sodium Bicarbonate Injection 8.4%, Amphastar (IMS)

50 mL syringe, 10 count (NDC 00548-3352-00)

50 mL Min-I-Jet (NDC 00548-1052-00) – discontinued

50 mL Stick-Gard (NDC 00548-2052-00) – discontinued

Sodium Bicarbonate Injection 8.4%, American Regent

50 mL vial (NDC 00517-1550-25) – discontinued

Sodium Bicarbonate Injection 7.5%, American Regent

50 mL vial (NDC 00517-0639-25) - discontinued

Sodium Bicarbonate Injection 4.2%, APP

5 mL vial (NDC 63323-0026-05)

Sodium Bicarbonate Injection 4.2%, Hospira

10 mL syringe, 10 count (NDC 00409-5534-34)

Sodium Bicarbonate Injection 7.5%, Hospira

50 mL syringe, 10 count (NDC 00409-4916-34)

Sodium Bicarbonate Injection 8.4%, Hospira

10 mL syringe, 10 count (NDC 00409-4900-34)

50 mL syringe, 10 count (NDC 00409-6637-34)

50 mL vial, 25 count (NDC 00409-6625-02)

Neut 4% sodium bicarbonate additive solution, Hospira

5 mL vial (NDC 00409-6609-02)

Reason for the Shortage

American Regent discontinued their sodium bicarbonate 8.4% and 7.5% 50 mL vials in late 2010.¹
Hospira had sodium bicarbonate on back order due to
manufacturing delays and increased demand for product. Hospira
discontinued their sodium bicarbonate 8.4% 50 mL Ansyr syringes in
August, 2009.²

APP has sodium bicarbonate on back order due to increased demand.³

Amphastar has sodium bicarbonate on back order due to increased demand.⁴

New Abstract being presented at the ISMICS (International Society of Minimally Invasive Cardiothoriacic Sugery) – June 2012

editor — Tue, 10 Apr 2012 14:06:11 +0000

REOPERATIVE MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT WITH AORTIC ROOT ENLARGEMENT
Sreekumar Subramanian, Christopher Piercecchi, Samata Paidy, John P. Duffy, Robert S. Poston.
University of Arizona Medical Center, Tucson, AZ, USA.
OBJECTIVE: Use of a minimally invasive …partial sternotomy approach for aortic valve replacement in patients with a prior sternotomy has been well described. However, combining this approach with an aortic root enlargement is a newer technique to avoid patient-prosthesis mismatch. We present a case to highlight several technical details that are critical to the success of this procedure.
METHODS: Chart review was performed of a 63-year old patient who underwent reoperation for minimally invasive aortic valve replacement after prior sternotomy and coronary artery bypass grafting.
RESULTS: Surgical access was achieved using an inverted T-incision. Cardiopulmonary bypass was established through the ascending aorta and the right femoral vein. No attempt was made to isolate the patent left internal mammary artery. Systemic cooling to 25° was performed. Single-shot Custodiol ®HTK was used for induction and maintenance cardioplegia. Given the 18 mm aortic annulus, a Nicks aortic root enlargement using a CorMatrix® extracellular matrix patch was performed, allowing implantation of a 21 Magna pericardial valve. Cross-clamp and cardiopulmonary bypass times were 68 and 111 minutes, respectively. TEE revealed good valve function and seating, with a mean gradient < 10. The patient recovered uneventfully, was discharged on postoperative day 3, and remains asymptomatic at short-term follow-up.
CONCLUSIONS: The minimally invasive partial sternotomy approach, particularly using an inverted T incision, gives excellent exposure to the ascending aorta in the reoperative setting, avoiding the need for significant cardiac dissection. Cardioplegia with single-shot Custodiol ® HTK is a useful adjunct. The addition of an aortic root enlargement is a feasible extension in selected cases of minimally invasive aortic valve replacement in the reoperative setting.

New Study out of Germany – Myocardial protection in minimally invasive mitral valve surgery:

editor — Mon, 26 Mar 2012 18:50:10 +0000

Objective: Minimal invasive mitral valve surgery using right thoracotomy is becoming a safe alternative and has an increasing impact in the clinical routine. The best strategy for myocardial protection for these patients is under discussion. Warm-blood cardioplegia, according to the protocol of Calafiore (group C), is well-established in coronary surgery throughout Europe, whereas the cold-crystalloid cardioplegia by Bretschneider (Custodiol®, group B) is in worldwide use in both heart surgery and organ transplantation.