Underwoodhong3039

As for a representative aortic surgery, total aortic arch replacement has been the most frequently performed procedure in Japan. When extensive atheromatous lesions are encountered around the arch and supra-aortic branches, rapid switching over to isolation of neck vessels and selective cerebral perfusion is recommended rather than solely relying on the right axillar artery perfusion. Retrograde cerebral perfusion may also be employed in a case with hostile cervical arterial lesions. Besides surgical strategy, peri-operative managements including preservation of renal and gastrointestinal functions are of paramount importance, and definitely influence the post-operative quality of life in patients with extensive atheromatous disease.Surgery for active infective endocarditis( IE) carries the greatest risk of any valve surgery, especially when complicated by cerebral infarction or bleeding. Surgical candidates with IE associated with neurologic symptoms should have a neurologic evaluation and brain imaging either by computed tomography (CT) or magnetic resonance imaging (MRI). Even among patients without neurologic symptoms, routine preoperative screening can be justified, especially those with high-risk vegetation. Current recommendations indicate that surgery should be delayed for 1 to 2 weeks in patients with non-hemorrhagic strokes and 3 to 4 weeks in patients with hemorrhagic strokes. If patients have suffered from stroke, any anticoagulation increases the risk of hemorrhagic conversion, and if bleeding has already occurred, this risk further increases. Accordingly, the treatment team has to make a difficult decision whether anticoagulation should be withheld or decreased. Transesophageal echocardiography (TEE) and/or transthoracic echocardiography (TTE) play a major role in determining the size of vegetation, abscess and fistula formation, and severity of regurgitation during the pre- and intra-operative periods. Cerebral MRI/CT are also important to diagnose the severity of cerebral infarction or bleeding before and after surgery. The risk of IE patients with cerebral complication may change by the hour, so a solid heart team approach is mandatory to make a prompt diagnosis and determine the optimal timing for surgery.Stroke is an important cause of morbidity and mortality after cardiovascular surgery and its incidence has been reported as 1.5 to 8.7%. Preexisting cerebrovasuclar disease, stenotic lesions of the carotid artery and atherosclerosis of the ascending aorta are known to be significant anatomic risk factors. To prevent perioperative stroke, it is important to discuss the onset mechanisms. Intraoperative stroke is mainly caused by the embolization of scattered atheroscrelotic plaque. Selleckchem LDC195943 Carotid duplex scanning and magnetic resonance imaging (MRI) are useful methods for the preoperative screening of cerebrovascular stenosis and plaque. Enhanced computed tomography (CT) is a powerful tool to estimate the presence of severe atheroscrelotic plaque in the aorta. When severe plaque is present, the manipulation, cannulation or clamping of the diseased aortic segment should be prevented. Insufficient oxygenated brain blood flow is thought to be another mechanism of intraoperative stroke. Impaired cerebral autoregulation during caridopulmonary bypass has been reported. Thus, it is recommended to maintain a high mean arterial pressure during cardiopulmonary bypass, especially in patients with cerebrovasuclar occlusive diseases. Postoperative stroke is mainly caused by embolization of the thrombus. To prevent this, excessive hypovolemia and atrial fibrillation should be avoided. Preemptive usage of beta blockers is one option for preventing postoperative atrial fibrillation.Oral transmucosal fentanyl has been indicated for the management of breakthrough pain in patients with cancer. Fentanyl sublingual tablets(FST)have been approved for use in Japan since 2013. However, the optimal use of FSTs has not been well-elucidated. In this case, a 73-year-old man with rectal cancer and third lumbar vertebral metastasis was treated with 100 μg FST and 12.5 μg/h fentanyl patch every day for the management of cancer-related breakthrough pain. After receiving the fourth dose of FST, the patient was unconscious for 2 days. However, his respiration was stable. This case shows that due care should be taken while administering FSTs to patients, specifically geriatric patients with bone metastasis and hypoalbuminemia.A 66-year-old male diagnosed with transverse colon cancer was admitted to our hospital. Computed tomography, colonoscopy, and esophagogastroduodenoscopy revealed locally advanced cancer with invasion of the gastric antrum. We staged the disease as cT4a, cN2, cM0, Stage ⅢB, with wild-type RAS expression. We performed an ileostomy prior to administering chemotherapy. The patient received 4 courses of modified FOLFOXIRI plus bevacizumab and 2 courses of FOLFIRI. The size of the tumor noticeably decreased after chemotherapy. The patient experienced grade 3 neutropenia, anorexia, and oral mucositis during chemotherapy. We performed a right hemicolectomy(D3), partial gastrectomy and ileum resection after administering neoadjuvant chemotherapy. The pathological stage of the disease was ypT2, ypN0, ypM0, ypStageⅠ, and the effect of the chemotherapy was Grade 1b. After the resection, he received mFOLFOX6 and CapeOX for 3 months as adjuvant chemotherapy. He remained cancer-free for 1 year and 3 months after the surgery. This result suggests that preoperative modified FOLFOXIRI plus bevacizumab chemotherapy is a useful regimen for the treatment of locally advanced colon cancer.Most primary gastric mucosa-associated lymphoid tissue(MALT)lymphomas are associated with a chronic Helicobacter pylori(H. pylori)infection. The eradication of H. pylori is the first-line treatment for H. pylori-positive cases with early-stage disease. In addition, successful treatment of H. pylori-negative early stage MALT lymphomas by eradication has been reported in several small cases series. However, the association of primary gastrointestinal MALT lymphomas with H. pylori in areas other than the stomach is not clear, and the efficacy of eradication therapy for these patients has not been established. We performed H. pylori eradication therapy for H. pylori-negative cecum MALT lymphoma. Three months later, a histopathological examination showed no evidence of MALT lymphoma, and the patient was classified as being in remission. So far, the patient has been in remission for 1 year and 6 months. Our case is the first report of successfully treating H. pylori- negative cecum MALT lymphoma with eradication therapy.