A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.

We performed a retrospective study of the effects of steroids and the factors that deteriorate renal function in 30 patients with primary focal segmental glomerular sclerosis. The mean observation periods from the onset of proteinuria and from the histological diagnosis by renal biopsy were 6.1 ± 5.0 years and 3.9 ± 3.01 respectively. 87% of the patients had been recerving steroid therapy with or without other drugs. In this study, the patients were divided into 3 groups by the initial dose of steroids. A multivariate analysis was performed on the laboratory findings of the 3 groups. In a short-term observation, there were no significant defferences among the groups. However, in a long-term observation (more than one year) it was clarified that the patients who had been given high doses of steroids tend to maintain their renal functoin. We also found that the patients responding to steroids showed a significantly better prognosis than steroid-resistant patients upon examination their nephrotic status and renal functoin.
This statistical analysis confirmed that the factors deteriorating the renal function are hypertension and hyperlipidemia.
In addition, it was revealed that hyperuricemia, is responsible for the renal dissease, failure?

 Our hospital comprises nine departments of internal medicine that specialize in different organs, and the Department of General Internal Medicine is one of these departments. The inpatient department has 30 beds for providing medical care, and education is provided for junior and senior residents. We examined the diagnoses in 593 cases (289 men, 304 women ; mean age, 64.2±21.2 years old) who were hospitalized in the Department of General Internal Medicine at this hospital between April 2007 and March 2008. The major diseases included pneumonia, 111 cases ; urinary tract infections, 44 cases ; infectious enteritis, 34 cases ; bronchial asthma, 24 cases ; fever of unknown origin, 12 cases ; heart failure, 11 cases ; viral infections 9 cases, diverticulitis, 8 cases ; malignant lymphoma, 7 cases ; infectious mononucleosis, 7 cases ; polymyalgia rheumatica, 6 cases ; and others. In order to provide diagnoses and treatments for cases in which no diagnosis could not be obtained on the first outpatient visit, for example, it is necessary to have a ward for general internal medicine as a location for providing medical care that is not limited to any specialized field.