Kyobu geka. The Japanese journal of thoracic surgery
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A Jehovah's Witness who requires thoracic and cardiovascular surgery represents a challenge to both the surgeon and the patient because of the patient's refusal to accept blood transfusion. We reported 15 cases of Jehovah's Witness patients from 43 to 80 years of age who underwent cardiac operations or thoracic vascular operations. There was 1 emergency operation case and 2 re-do operation cases. ⋯ There were no postoperative complications and no operative deaths. We successfully performed the thoracic and cardiovascular operations on Jehovah's Witnesses, including emergency cases, safely without blood transfusion. The most important thing is a careful and safe operative technique which reduces perioperative bleeding as much as possible.
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Case Reports
[Perioperative nutritional support with immune-enhancing diet for surgical closure of open thoracic window].
Immunonutrition, which is a therapeutic approach to modulate acute surgical or medical conditions, has been proven to decrease surgical site complications in patients undergoing major elective surgery for upper gastrointestinal and esophageal malignancy. For immunonutrition to be carried out effectively, specific nutrients called pharmaconutrients are quite important. ⋯ The open thoracic window for chronic empyema caused by postoperative bronchopleural fistula was successfully closed. Perioperative immunonutrition is likely to have beneficial effect in decreasing postoperative infectious complications in high-risk malnourished thoracic surgical patients.
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Liver cirrhosis has been shown a major preoperative risk factor in patients undergoing cardiac surgery. Although recent evidence comes from limited studies with relatively small number of patients, morbidity and mortality progressively increase with the severity of liver dysfunction. Patients with Child-Pugh classification B or C have significantly higher risks after open heart surgery using cardiopulmonary bypass. ⋯ Preoperative optimization of medical condition by correcting coagulopathy, poor nutrition, fluid retention and renal function is important in patients with high predictive risks. Non-cardiovascular morbidities including malignancies or hepatic decompression are the major limiting factors for long term survival. Careful consideration of expected risks and benefits is required to determine the surgical indication in those patients.
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Acute exacerbation( AE) of idiopathic pulmonary fibrosis( IPF) is the most common cause of postoperative mortality after lung cancer surgery. ostoperative mortality rate of lung cancer patients with IPF has been reported to range approximately from 3% to 15%. The degree of fibrosis on preoperative high-resolution computed tomography( CT), preoperative high serum levels of KL-6, lactate dehydrogenase(LDH), and C-reactive protein( CRP), and preoperative low %TLC, %VC, and %diffusing capacity of CO( DLco) in pulmonary function test have been reported as the predictive risk factors for postoperative AE, but the clinical relevance remains controversial. Most of reports regarding the 5-year survival rate after resection of lung cancer with IPF have been ranged between 40% and 60%, and significantly poorer than that without IPF. ⋯ A number of prophylactic strategies against AE have been reported in the literature, but none of them has been generally established. A nationwide survey concerning postoperative AE after resection of lung cancer with pulmonary fibrosis has been conducted in Japan, and the final results will be reported soon. Based on the outcomes of the survey, standard strategy for the treatment of lung cancer with IPF is expected to be established.6.