Kyobu geka. The Japanese journal of thoracic surgery
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A 65-year-old woman with type Ⅱ diabetes and unstable angina presented with chest pain due to in-stent restenosis. Her regular medication comprised an sodium-glucose co-transporter( SGLT) 2 inhibitor. Because of unstable hemodynamic status, semi-emergency coronary artery bypass grafting (CABG) was performed. ⋯ Guidelines in other countries have stipulated that SGLT2 inhibitor should be stopped 24 hours preoperatively. In our case, euglycemic DKA occurred even when the SGLT2 inhibitor was stopped for more than 24 hours preoperatively. Further studies on the withdrawal of an SGLT2 inhibitor in the appropriate perioperative period are required.
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Only a few studies have examined the effects of regular acetaminophen drip infusion as postoperative analgesia in lung cancer surgery. ⋯ Postoperative analgesia with acetaminophen was conducted safely, but its effect on postoperative pain did not differ from the conventional analgesia.
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Case Reports
[Off-pump Coronary Artery Bypass Grafting in Jehovah's Witness Patient on Hemodialysis;Report of a Case].
Cardiac surgery in Jehovah's witnesses is challenging due to their refusal of blood transfusion. Furthermore, dialysis patients often suffer from anemia and are also prone to bleeding. We performed offpump coronary artery bypass grafting (CABG) [OPCAB] on a Jehovah's witness male patient on hemodialysis. ⋯ We used cell saver-collected blood as much as possible during operation. His postoperative course was uneventful with the lowest hemoglobin level of 7.2 g/dl using iron supplements and erythropoietin. This case indicates that intraoperative blood salvage and perioperative management of anemia make OPCAB without blood transfusion possible even in Jehovah's witness hemodialysis patients, when their preoperative hemoglobin levels are maintained greater than 10.0 g/dl.
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The SOLO SMART valve is a bovine pericardial stentless bioprosthesis which shows superior hemodynamic performance compared to the stented valves. It is designed for supraannular and subcoronary implantation. We report our surgical experience and results in patients undergoing aortic valve replacement(AVR) with this new bioprosthesis. ⋯ AVR using a SOLO SMART stentless bioprosthesis was performed with acceptable morbidity and mortality. The SOLO SMART stentless bioprosthesis showed excellent hemodynamic performance and early results. Because of favorable effective orifice area, the valve is attractive for patients at risk for PPM. Furthermore, it is expected to contribute to more complex AVR with concomitant mitral valve surgery, active IE or redo situation.
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Case Reports
[Sternal Nonunion after Open Heart Surgery through a Partial Sternotomy;Report of a Case].
Sternal nonunion is an uncommon complication after a sternal wound and some cases have been reported as a complication of open heart surgery. A 28-year-old male suffered from persistent sternal pain. Six years ago, open heart surgery was performed through a partial sternotomy with transverse sternotomy. ⋯ Three years later, the patient experienced recurrence of persistent sternal pain with clicking, because all of the sternal wires had ruptured and the sternal healing was incomplete. The patient was treated with adequate debridement and a technique using metal plates and autogenous bone grafts, which provided excellent pain relief. A transverse sternotomy potentially exposes the patient to the risk of sternal nonunion, which should be treated using autogenous bone grafting.