We report a case of cholesterol crystal embolism (CCE) after endovascular aortic repair for abdominal aortic aneurysm (AAA). A 68-year-old man with AAA underwent endovascular aortic repair. He complained of left lower abdominal pain after the operation. Abdominal CT showed renal infarction on postoperative day 10. Renal dysfunction developed after postoperative day 17. A biopsy of the renal infarct lesion demonstrated characteristic cholesterol clefts in the small arteries. We diagnosed CCE. Steroid therapy was administered and the patient's condition improved remarkably. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind.

Immunoglobulin G4 (IgG4)-related disease can occur in various organs, most of which comprise glandular or ductal tissue. We report a case of IgG4-related disease which occurred in a cardiovascular lesion. A 69-year-old man was found to have a tumorous lesion around the coronary artery. Open chest biopsy showed the diffuse lymphoplasmacytic infiltration, occasional eosinophils and numerous IgG4-positive plasma cells within the lesions. The serum concentration of IgG4 in the postoperative period was 1,080 mg/dl (reference range, <135). We diagnosed IgG4-related periarteritis manifesting as a tumor around the coronary artery. This case suggests that IgG4-related disease can occur around the coronary artery and manifest as a periarterial mass lesion.

Case reports of traumatic aortic regurgitation are rare. We report a case of a 62-year-old man injured by falling from a paraglider. After recovering from multiple injuries and discharge, he began to suffer from dyspnea. Severe aortic regurgitation and pseudoaneurysm of the sinus of Valsalva were diagnosed by ultrasound cardio graphy (UCG) and multi-detector-row computer tomography (MDCT). After cardiac failure was controlled, we operated. The commissure between the left and the right coronary cusps was detached from the aortic wall, and a modified Bentall operation was performed. The patient recovered well and was discharged uneventfully.

No abstract available.
Colon*

Accidents involving metals brought into the MRI room are occurring with increasing frequency. The Japan Council for Quality Health Care has released medical safety information about bringing magnetic materials into the MRI room, showing that this is an important safety issue. In our hospital, there were 4 accidents involving metal brought into the MRI room between April 2012 and March 2016. One serious incident was a projectile accident involving scissors carried by a nurse. In response, we have adopted new preventive measures, including specialized uniforms and a color-coding scheme for indicating MRI-safe and MRI-unsafe items (using colored tape, etc.). Here we report on the effect of these accident prevention efforts.