Comparison of St. Thomas II Cardioplegia and Modified Del Nido Cardioplegia in Dogs Undergoing Mitral Valve Surgery.

Myocardial protection has become an essential adjunctive procedure in veterinary cardiac surgery. Del Nido cardioplegia is a good alternative to the traditional St. Thomas II (ST) cardioplegia in open heart surgery in humans. This study aims to compare intra- and postoperative results between ST cardioplegia and modified del Nido (mDN) cardioplegia in mitral valve surgery in dogs with myxomatous mitral valve disease (MMVD). This retrospective study was conducted using clinical records of 16 MMVD dogs that underwent either ST or mDN cardioplegia. We measured cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, total operation time, the number of cardioplegia doses, total amount of cardioplegia, required defibrillations, in-hospital mortality and pre- and one-month postoperative echocardiographic variables. CPB (159.4 ± 16.1 vs. 210.1 ± 34.0 min), ACC (101.4 ± 7.0 vs. 136.0 ± 24.8 min) and total operation time (262.3 ± 13.1 vs. 327.0 ± 45.4 min) were significantly shorter in the mDN group (p < 0.05). The number of cardioplegia doses (3.25 ± 0.4 vs. 6.25 ± 1.2) and total amount of cardioplegia (161.3 ± 51.5 vs. 405.0 ± 185.9 mL) in the mDN group were also significantly smaller than the ST group (p < 0.05). No difference was observed in the requirement of defibrillation, in-hospital mortality and pre- and postoperative echocardiographic variables. The utilization of mDN cardioplegia was associated with shorter operative time in mitral valve surgery in dogs.

Clinical investigation of use of Episil® oral solution in oral mucositis during radiotherapy for head and neck cancer.

Objective: Episil® is a bio adhesive barrier-forming oral liquid gel that has been used in recent years to relieve pain of oral mucositis (OM) with radiotherapy (RT) or chemoradiotherapy (CRT) in head and neck cancer (HNC) patients. We conducted a retrospective analysis of the clinical effects of Episil® on OM in these patients. Study design: Between June 2018 and May 2020, 65 patients with HNC were treated with RT or CRT at our hospital. Results: The median total RT dose was 50 Gy (range, 30-70 Gy) and the completion rate was 63/65 (97%). The median time to OM resolution was 47 (6-90) days and was significantly longer (53 [27-90] days) when the total RT dose was ≥51 Gy (P < 0.001). Episil® was used in 26 patients. Among them, 10 discontinued its use due to ineffective pain relief, usage difficulties, and taste intolerance. The median duration of use was 30 days and was significantly longer (34.5 days) (P < 0.001) when patients experienced pain relief at treatment initiation. Conclusion: Although Episil® has been shown to be effective in improving the pain of OM caused by RT for HNC patients, and medical professionals are required to give careful attention to each patient.

Development of Pulmonary Edema Despite Negative Fluid Balance with Diuretics in a Patient with Heart Failure and Sigmoid Septum.

An 87-year-old man was hospitalized due to dyspnea and leg edema. He was diagnosed with heart failure due to anemia with a hemoglobin (Hb) concentration of 6.0 g/dL. Chest X-ray on admission revealed pleural effusion. He was transfused with 400 mL packed red blood cells, which elevated the Hb concentration to 8.6 g/dL. Spironolactone (25 mg/day) and furosemide (20 mg/day, intravenously) were initiated. Despite the negative fluid balance, the patient's dyspnea worsened. Chest X-ray on day 8 revealed pulmonary edema despite decreased pleural effusion. Transthoracic echocardiography (TTE) revealed a sigmoid-shaped interventricular septum and systolic anterior motion of the mitral valve, causing left ventricular outflow tract obstruction (LVOTO; peak pressure gradient, 96 mmHg). Pilsicainide (75 mg/day) was administered to reduce the LVOTO. In addition, furosemide administration was changed to continuous infusion with increased dose of 48 mg/day (2 mg/h). The patient's dyspnea finally abated, with X-ray on day 12 revealing marked reduction in pulmonary congestion. TTE on day 17 revealed marked reduction in LVOTO (peak pressure gradient, 21 mmHg). Hemodynamic change by diuretics in the setting of right-sided heart failure due to anemia and in the presence of LVOTO due to sigmoid septum could be the cause of pulmonary edema.

Irreversible metronidazole encephalopathy in an elderly woman with primary biliary cholangitis.

An 82-year-old woman with primary biliary cholangitis was diagnosed with an irreversible neurological disorder, caused by metronidazole (MNZ)-induced encephalopathy. Although the disorder is a reversible pathological condition, in rare cases, it can cause serious sequelae or could even be fatal. Therefore, medications should be administered carefully, particularly in patients who require long-term administration of large doses or those with liver dysfunction.