The patient was a 65-year-old man who had undergone AVR (SJM Regent : 19 mm) for AR in June 2007. Since March 2008 there had been an increase in the pressure gradient between the aorta and the left ventricle on transthoracic echocardiography (peak PG : 46 mmHg, mean PG : 27 mm Hg). Plain x-ray films of the valve showed limited opening of the metallic valve. However, no symptoms of heart failure were observed on a physical examination. Blood tests performed in December 2007 showed a PT-INR value of 1.22. Since the effects of warfarin anticoagulant therapy were insufficient, its dose was adjusted on follow-up. An examination in June revealed further stenosis of the valve (peak PG : 93 mmHg, mean PG : 58 mmHg). Valve thrombosis was suspected because the condition was poorly controlled by warfarin. Thus, thrombolytic therapy using t-PA was performed (800,000 units). However, the patient complained of chest pain 1 h 30 min after initiation of thrombolytic therapy. Twelve-lead electrocardiography was performed, and ST-segment elevations were observed in the limb and chest leads. Acute myocardial infarction due to a free-floating thrombus was suspected, and emergency cardiac catheterization was performed. Segment 7 was totally occluded, and reperfusion was achieved by thrombus aspiration. Embolization of the coronary artery was speculated to have occurred because of the improved mobility of the metallic valve and dissolution of a thrombus adhering to the valve. A case of acute myocardial infarction as a complication of thrombolytic therapy for valve thrombosis is rare. This case reaffirms the necessity of careful monitoring during thrombolytic therapy.

CHDF was applied to 8 patients who developed acute renal failure following cardiogenic shock. Four of 8 patients also underwent PCPS (percutaneous cardiopulmonary bypass) and all were weaned from PCPS. Five patients were weaned from CHDF. CHDF was very effective to control the concentration of serum potassium, creatinine, blood urea nitrogen and diuresis.

Surgical treatment of abdominal aortic aneurysms in elderly patients aged over 90 is rare, and the surgical indications in such patients is controversial. Two cases of abdominal aortic aneurysm successfully treated surgically are reported. The first case was a 92-year-old woman, who manifested a severe abdominal pain without hypotension. An impending rupture of an abdominal aortic aneurysm was suggested on enhanced CT scan, and emergency surgery was indicated. The aneurysm was replaced with a woven Dacron Y-graft. Postoperatively, the patient's social activity returned to the preoperative level. The second case was a 91-year-old man, in whom an increasing abdominal aortic aneurysm had been pointed out on UCG and enhanced CT scan. Because he was socially very active for his age, elective surgery was indicated. The aneurysm was resected and replaced with a woven Dacron I-graft. Postoperatively, the patient overcame a respiratory complication and was eventually discharged without any physical complication. Although he was able to climb mountains before the surgery, he lost some physical activity after the surgery. Because of the potential decrease in physical strength especially in very elderly patients, the general risk evaluation did not always correspond to a precise evaluation and prediction of postoperative activity. It is therefore necessary to be flexible in deciding on the surgical indications in each case.

Background
 According to the state of the world's children 2006, 28% of children under five years of age in sub-Sahara Africa are malnourished, which has serious effects on these children's health and lives.
 Extensive research has been conducted on child malnutrition in a variety of developing countries. These studies have established scientific indexes to lead and coordinate international action to assist the needy. Central African Republic, however, has been a blind spot. Therefore, the present study was conducted in order to clarify the nutritional status and associated factors of 6 to 24-month-old children in the district of Boy-rabe, Bangui, Central African Republic.
Methods
 Participants were mothers with children aged 6-24 months who visited either a government-run clinic or the NGO-run clinic, Amis d'Afrique, between August 26th and September 16th of 2006. Mothers were interviewed using a structured questionnaire and measurements of the children's weight and length were collected. Weight, length, and age data were compared with child growth standards proposed by the WHO to calculated z-scores for evaluatinglength-for-age (wasting), weight-for-length (stunted growth), and weight-for-age (underweight). The following factors were investigated for their association to malnutrition in children: “demographic characteristics”, “access to food”, “maternal and child-care practices”, and “poor water/sanitation and inadequate health services”.
Results
 A total of 126 mother-child pairs participated in this study and valid data from 109 pairs were subjected to analysis. The rates of wasting, stunted growth, and underweight children were 20.2%, 61.5% and 42.2%, respectively.
 Incomplete vaccination (p=0.043) and the mother not having a partner (p=0.046) were significantly associated with wasting. Stunted growth was found to be associated with older child's age (p<0.001), older mothers' age (p=0.005), mothers who had stopped breast-feeding (p=0.031), insufficient breast-feeding (p=0.032), mothers with child death experience (p=0.022), mothers with a number of delivery experiences (p=0.026) and mothers with a partner (p=0.042). Underweight children were associated with incomplete vaccination (p=0.043) and mothers with child death experience (p=0.046).
Conclusion
 In total, 8 factors were found to be significantly associated with child's malnutrition and household/family level. In particular, severe acute malnutrition, or wasting, was related to insufficient vaccination, while chronic malnutrition, or stunted growth, was significantly associated with breast-feeding.

For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as “secondary intracranial hypertension,” and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives. Other reports pointed out the importance of obesity, which may cause an impairment of intracranial venous drainage due to elevated right atrial pressure. Patients with medically refractory IIH have traditionally undergone a CSF diversion. Venous outlet impairment on IIH has recently been reported as a causative or contributory cause, and thus focused venoplasty of the stenotic sinus with a stent has emerged as a new treatment strategy. We report the cases of two patients who presented with headache and papilledema with IIH. They successfully underwent stent placement at the stenosis of the transverse sinus and experienced complete resolution of symptoms.
Absorption ; Atrial Pressure ; Brain Edema ; Cerebrospinal Fluid ; Constriction, Pathologic* ; Drainage ; Headache ; Humans ; Obesity ; Papilledema ; Pseudotumor Cerebri* ; Sleep Apnea, Obstructive ; Stents* ; Vitamin A

PURPOSE: Conventional coil embolization for large carotid cavernous aneurysms (CCAs) has limited utility due to its inability to prevent recurrences and reduce mass effect. Trapping of the parent artery may have a risk of ischemic complications due to intracranial perfusion disorders. We successfully treated 24 patients with large CCAs using a flow diverter (Pipeline™ embolic device: PED), and this report discusses the safety and efficacy of this method. MATERIALS AND METHODS: Twenty four patients (23 females, mean age 71.5 years old) with large CCAs, including 6 giant CCAs, were treated with a PED over three years. Under sufficient dual anti-platelet management, the PED was deployed over the orifice of the aneurysm. Two patients required multiple telescoping stents. Clinical and radiological states were checked with MRI at 1, 3 and 6 months post-surgically. Angiographic follow-up was performed at 6 months. RESULTS: In all patients, PED was appropriately deployed. Stagnation of contrast with eclipse signs was observed post-angiogram in 21 cases. One patient requiring 5 telescoping stents experienced temporary ischemic symptoms. Fourteen patients experienced improvement of ocular motor impairment deficiency, including 6 patients who recovered. Angiograms at 6 months follow-up showed complete occlusion in 63% (12/19) of patients, and MRI showed reduction of aneurysm volume in 89% (17/19) of patients. CONCLUSION: Flow diverters for large CCAs showed promising clinical and radiological efficacy. They can shrink the aneurysm and improve symptoms without sacrificing the parent artery. It will be necessary to summarize the cases and to verify the long-term results.
Aneurysm* ; Arteries ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Methods ; Parents ; Perfusion ; Recurrence ; Stents