Objective: Both acyclovir (ACV) and valacyclovir (VACV) can cause drug-induced encephalopathy, which occurs primarily in patients with renal impairment because of delayed drug metabolism. Here, we report a case of ACV-associated encephalopathy precipitated by the addition of nonsteroidal anti-inflammatory drugs (NSAIDs).Patient: A 97-year-old woman with a 1-d history of altered consciousness was admitted to our hospital. After treatment with ACV and VACV for herpes zoster, NSAIDs were introduced for pain 5 d prior to admission. VACV and NSAIDs were subsequently administered by her primary care physician 3 d before admission.Results: The patient presented with altered consciousness and acute kidney injury, leading to a suspicion of ACV-associated encephalopathy. Her consciousness improved rapidly with hemodialysis. We diagnosed ACV-associated encephalopathy based on a significantly elevated ACV blood level of 32.7 µg/dL.Conclusion: The addition of NSAIDs during ACV or VACV administration may precipitate ACV-associated encephalopathy. When combining ACV or VACV with NSAIDs for the treatment of herpes zoster, careful monitoring of consciousness level and renal function is recommended.

When performing aortic valve replacement in young patients, mechanical valves are recommended due to their durability. However, because mechanical valves require lifelong use of warfarin and carry risks such as easy bleeding, bioprosthetic valve replacement may be performed in some cases even in young patients. In this report, we describe a case of a patient who underwent bioprosthetic aortic valve replacement with aortic annular enlargement in anticipation of TAV in SAV and had a good postoperative course. The patient is a 51-year-old male. He was referred to our hospital for surgical treatment of severe aortic stenosis. The patient strongly preferred a bioprosthetic valve due to the disadvantage of taking warfarin. Therefore, we considered the possibility of TAV in SAV due to his young age, and decided to perform aortic annular enlargement if necessary. Intraoperatively, after resection and decalcification of the valve, a sizer was inserted, but the 19 mm sizer could not pass through, so we decided to perform aortic annular enlargement. Aortic annular enlargement was performed by suturing a Dacron patch and implantation of a 23 mm bioprosthetic valve. The patient had no major postoperative problems and was discharged home on the 14th day after surgery. In order to avoid PPM in the future when TAVI is performed, aortic annular enlargement should be considered in young patients undergoing aortic valve replacement using a bioprosthetic valve if TAV in SAV is considered to be difficult.

Pericardial pacing wire placement may occasionally result in intravascular or intratracheal wire migration, infective endocarditis, and sepsis; reportedly, the incidence of complications is approximately 0.09 to 0.4%. We report a case of a retained epicardial pacing wire that migrated into the pulmonary artery. A 66-year-old man underwent coronary artery bypass grafting for angina pectoris, with placement of an epicardial pacing wire on the right ventricular epicardium, 6 years prior to presentation. Some resistance was encountered during wire extraction; therefore, it was cut off at the cutaneous level on postoperative day 8. Computed tomography performed 6 years postoperatively revealed migration of the pacing wire into the pulmonary artery, and it was removed using catheter intervention. Surgeons should be aware of complications associated with retained pacing wires in patients in whom epicardial wires are retained after cardiac surgery.

A 57-year-old man, who had suffered chest, back and right leg pain about 10 years before, underwent CT and was found a chronic type B aortic dissection with an enlarged false lumen and a narrowed true lumen that was occluded at the infrarenal abdominal aorta. A conventional surgical repair seemed to be too high risk considering his comorbidities, thus we chose a staged hybrid repair. First, surgical repair of the abdominal aorta with an abdominal aortic fenestration was performed. Then, one month after the first operation, zone 2 thoracic endovascular aortic repair with left carotid-axillary artery bypass was performed. At the second operation, the stent graft was purposely deployed from zone 2 into Th12 level of a false lumen through the fenestration followed by coil embolization of a true lumen just distal to the entry tear. The postoperative course was uneventful and he had no complications at 6 months follow-up. Deploying stent graft into a false lumen could be a feasible option in case deploying into a true lumen is not suitable if the anatomical condition permits.

We report a 48-year-old man who underwent hybrid aortic repair for visceral aortic patch (VAP) aneurysm. He had undergone descending thoracic aortic repair for post-dissection aneurysm at the age of 25, ascending aorta and proximal aortic arch aneurysm repair at the age of 27, and residual thoracoabdominal dissecting aortic aneurysm repair with VAP reconstruction at the age of 28. During 20 years of follow-up, the VAP gradually enlarged and eventually reached 70×61 mm in diameter. Considering a possible severe adhesion after 2 previous left thoracotomies, we planned a 2-staged hybrid aortic repair. First, we performed reno-visceral debranching and as a second stage operation, endovascular aortic repair was performed successfully 39 days after the first-stage operation.

A 52-year-old man underwent a medical examination, including abdominal computed tomography (CT). Abdominal CT revealed a common hepatic artery aneurysm (25 mm in diameter) ; a portion of the aneurysm depressed the pancreas. The gastroduodenal artery branched off the common hepatic artery aneurysm. We planned coil embolization for the common hepatic artery aneurysm. However, we could not avoid occluding the proper hepatic artery ; therefore, we performed abdominal aortic-proper hepatic artery bypass with coil embolization. The patient's postoperative course was uneventful.

Background: Few studies have investigated the relationship between serum total carbon dioxide (CO2) concentration and bicarbonate ion (HCO3-) concentration in patients undergoing hemodialysis. We determined the agreement and discrepancy between serum total CO2and HCO3- concentrations and the diagnostic accuracy of serum total CO2 for the prediction of low (HCO3- < 24 mEq/L) and high (HCO3- ≥ 24 mEq/L) bicarbonate concentrations in hemodialysis patients. Methods: One hundred forty-nine arteriovenous blood samples from 84 hemodialysis patients were studied. Multiple linear regression analysis was used to determine factors correlated with HCO3- concentration. Diagnostic accuracy of serum total CO2 was evaluated using receiver operating characteristic curve analysis and a 2 × 2 table. Agreement between serum total CO2 and HCO3- concentrations was assessed using Bland-Altman analysis. Results: Serum total CO2 concentration was closely correlated with HCO3- concentration (β = 0.858, P < 0.001). Area under the curve of serum total CO2 for the identification of low and high bicarbonate concentrations was 0.989. Use of serum total CO2 to predict low and high bicarbonate concentrations had a sensitivity of 100%, specificity of 50.0%, positive predictive value of 96.5%, negative predictive value of 100%, and accuracy of 96.6%. Bland-Altman analysis showed moderate agreement between serum total CO2 and HCO3- concentrations. Discrepancies between HCO3- and serum total CO2 concentrations (serum total CO2 - HCO3- ≤ -1) were observed in 89 samples. Conclusion Serum total CO2 concentration is closely correlated with HCO3- concentration in hemodialysis patients. However, there is a non-negligible discrepancy between serum total CO2 and HCO3- concentrations.

Background: Few studies have investigated the relationship between serum total carbon dioxide (CO2) concentration and bicarbonate ion (HCO3-) concentration in patients undergoing hemodialysis. We determined the agreement and discrepancy between serum total CO2and HCO3- concentrations and the diagnostic accuracy of serum total CO2 for the prediction of low (HCO3- < 24 mEq/L) and high (HCO3- ≥ 24 mEq/L) bicarbonate concentrations in hemodialysis patients. Methods: One hundred forty-nine arteriovenous blood samples from 84 hemodialysis patients were studied. Multiple linear regression analysis was used to determine factors correlated with HCO3- concentration. Diagnostic accuracy of serum total CO2 was evaluated using receiver operating characteristic curve analysis and a 2 × 2 table. Agreement between serum total CO2 and HCO3- concentrations was assessed using Bland-Altman analysis. Results: Serum total CO2 concentration was closely correlated with HCO3- concentration (β = 0.858, P < 0.001). Area under the curve of serum total CO2 for the identification of low and high bicarbonate concentrations was 0.989. Use of serum total CO2 to predict low and high bicarbonate concentrations had a sensitivity of 100%, specificity of 50.0%, positive predictive value of 96.5%, negative predictive value of 100%, and accuracy of 96.6%. Bland-Altman analysis showed moderate agreement between serum total CO2 and HCO3- concentrations. Discrepancies between HCO3- and serum total CO2 concentrations (serum total CO2 - HCO3- ≤ -1) were observed in 89 samples. Conclusion Serum total CO2 concentration is closely correlated with HCO3- concentration in hemodialysis patients. However, there is a non-negligible discrepancy between serum total CO2 and HCO3- concentrations.

We describe a 50-year-old man who was diagnosed with anomalous aortic origin of the right coronary artery (AAORCA) by coronary angiography and coronary computed tomography performed for chest pain on exertion. Exercise-loaded myocardial scintigraphy revealed inferior wall ischemia, and hence surgery was performed. Intraoperatively, the right coronary artery was seen to run in the aortic wall, and hence, right coronary ostioplasty (unroofing) was performed. Postoperatively, coronary computed tomography revealed that the right coronary artery originated from a normal position, and exercise-loaded myocardial scintigraphy indicated no ischemia.