“Depolarized arrest”, induced by hyperkalemic (moderately increased extracellular potassium) cardioplegia is the gold standard to achieve elective temporary cardiac arrest in cardiac surgery. Hyperkalemic cardioplegic solutions provide good myocardial protection, which is relatively safe, and easily and rapidly reversible. However, this technique has detrimental effects associated with ionic imbalance involving sodium and calcium overload of the cardiac cell induced by depolarization of the cell membrane. Hence, the development of an improved cardioplegic solution that enhances myocardial protection is anticipated as an alternative to hyperkalemic cardioplegia. In this review, we assess the suitability and clinical potential of cardioplegic agents to induce “non-depolarized arrest” from the viewpoint of rapid cardiac arrest, myocardial protection, reversibility, and toxicity. “Magnesium cardioplegia” and “esmolol cardioplegia” have been shown to exert superior protection with comparable safety profiles to that of hyperkalemic cardioplegia. These alternative techniques require further examination and investigation to challenge the traditional view that hyperkalemic arrest is best. Endogenous cardioprotective strategies, termed “ischemic preconditioning” and “ischemic postconditioning”, may have a role in cardiac surgery to provide additional protection. The elective nature of cardiac surgery, with the known onset of ischemia and reperfusion, lends it to the potential of these strategies. However, the benefit of preconditioning and postconditioning during cardiac surgery is controversial, particularly in the context of cardioplegia. The clinical application of these strategies is unlikely to become routine during cardiac surgery because of the necessity for repeated aortic crossclamping with consequent potential for embolic events, but offers considerable potential especially if “pharmacological” preconditioning and postconditioning could be established.

　　It usually takes several days to detect slow-growing bacteria by a blood culture system. Moreover, even if the microbial growths are detected in blood samples, they will escape our notice at a microscopic examination using Gram’s stain. Consequently, the results are often regarded as false positive.　　This paper reports case of malignant lymphoma in which bloodstream infection caused by slow-growing spirillum was observed. The patient in chemotherapy for malignant lymphoma, complained of repeated fever. Repeated blood cultures were taken and occasionally positive signals, which mean increased CO2 concentrations in the culture bottle, were detected by BACTEC 9240 (Becton Dickinson). However, routine microscopic examination with Gram’s stain did not detect any bacteria. Thus, the results of BACTEC were thought to be false positive. Thereafter, the bacterial culture period was extended. Finally, a spirillum, suspected of one of Helicobacter species, was observed microscopically. The detected spirillum was regarded as Helicobacter canadensis with 98.08% homology, using polymerase chain reaction with the 16S rRNA method and basic local alignment search tool (BLAST).　　H. canadensis is one of new species isolated from humans with diarrhea. This bacterium is considered to cause a zoonotic infection. There have been some case reports that this bacterium infected immunosuppressive patients, so we should exercise caution against such conditions. Moreover, we should keep vigilant against the spread of slow-growing bacteria when there are discrepancies in findings between blood culture system and microscopic examination. It is useful to extend the culture period to detect such slow-growing bacteria.

Since the Infection Control Team (ICT) was organized in 1999, our hospital has been engaged in evidence-based operations against nosocomial infections. The ICT's major activities included guidance in preventive measures against infections, surveillance involving continuous environmental monitoring, proposition as regards prescription of antibacterial medicines, and consultation with clinicians about prophylaxis. The team comprising physicians, nurses, pharmacists and clinical laboratory technicians has made expert propositions to clinicians. To be concrete, the team members, with the liaison clerk playing a central role, met with physicians in charge or with other staff members of the hospital, studied the infection cases in question, and presented the study findings to the clinicians. Fundamentally, therefore, it is not that the ICT intervenes in the affairs of the clinical department by way of directions but that it presents clinicians with the ideas gained through discussion between ICT members and physicians and other hospital staffers. While cementing a relationship of mutual trust between hospital employees, the ICT is expected to engage in nosocomial infection prevention activities by joining forces transdeoartmentally.
Clinical ; Hospitals ; Infection Control ; seconds ; Prophylactic

As part of U-40 activities, chapters have traditionally held sessions of lectures and hands-on as the Basic Lecture Course (BLC) to improve the basic skills and knowledge of young cardiovascular surgeons. Because of the COVID-19 epidemic, we have shifted our activities from onsite to online. This column focuses on “management of postoperative delirium and pain” in the lecture of “Postoperative Management in Cardiovascular Surgery” given by the Chubu Chapter in 2020. We summarize the lecture and report the results of a questionnaire survey of the U-40 members.