Gastrointestinal Complications after Cardiovascular Surgery with Cardiopulmonary Bypass

Purpose: The purpose of this study was to examine the incidence, clinical features, treatment and outcome of patients with gastrointestinal complications after cardiovascular surgery in our hospital. Patients and Methods: Between January 1992 to February 2004, 835 patients were operated with cardiopulmonary bypass (CPB) at Gunma University Hospital. Of these, 12 (1.4%) patients had postoperative gastrointestinal complications. The mean age of 12 patients was 59 years old ranging from 7 to 71. Valve replacements were performed in six patients, CABG in three, and others in three. Results: Gastrointestinal bleeding occurred in seven patients. Six of them recovered with non-surgical procedure, and one died of hemorrhagic shock following an emergency operation. Acute cholecystitis occurred in three patients and all of them were successfully managed by percutenous transhepatic gall bladder drainage (PTGBD). Two patients with gastrointestinal perforation underwent an emergent operation, however, both of them died of sepsis. The total mortality rate of 12 patients was 25%. Conclusion: The occurrence of gastrointestinal complications after cardiovascular surgery with cardiopulmonary bypass is low, however, is frequently fatal. Preoperative careful evaluation of patients is required for the postoperative management of those complications

Sub-acute Toxicosis Caused by a Multiple Doses Tegafur/Uracil (UFT) for Suicide : A Case Report

Tegafur/uracil (UFT) is an oral anticancer drug composed of tegafur which is a derivative of fluorouracil (5-FU) and uracil in a molar ratio of 1:4. UFT is effective as adjuvant chemotherapy for breast cancer2, colorectal cancer3, non-small cell lung carcinoma4, head and neck cancer5 and other tumors. We report a 41-year-old man who orally ingested a large dose of UFT (tegafur: 40000 mg/ uracil 9960mg)in an effort to commit suicide, and suffered from sub-acute toxicosis(main symptoms were bone-marrow suppression, and hair loss) of UFT. His life was saved by empiric antibiotic chemical treatment (meropenem, isapamicin, and micafungin), and granulocyte colony-stimulating factor (G -CSF). In the case of toxicosis of UFT, strong antibacterial empiric chemotherapy and G-CSF are necessary for rescue. If G-CSF is not work, biopsy of bone marrow woud be necessary, and the case of no stem cells, bone marrow transfusion should be thought