We report a rare case of a large thrombus in the ascending aorta with acute arterial occlusive disease. A 61-year-old man was transferred to our hospital with sudden pain and cyanosis. Contrast-enhanced computed tomography detected left ulnar arterial occlusion and a large mass in the ascending aorta, so we performed surgery to remove the large thrombus under cardiopulmonary bypass. Histologically, the mass was a fibrin thrombus. In addition, thickened endothelial lining and slight atheromatous degeneration was detected in the resected aortic wall. The patient was discharged from the hospital on postoperative day 22.

A 68-year-old woman with multiple gastric ulcers was admitted to our hospital due to post-prandial abdominal pain. Multirow detector computed tomography (MDCT) showed severe stenoses of both the celiac trunk and superior mesenteric artery (SMA) ; therefore, we decided to operate based on the presumed diagnosis of abdominal angina. We bypassed the stenoses using a saphenous vein graft from the right external iliac artery to the SMA, distal to the stenosis. The patient was symptom-free postoperatively. In summary, this case of abdominal angina was accurately evaluated preoperatively with MDCT and the flow meter^®. Thereafter, a focal stenosis in the superior mesenteric artery was successfully treated with an external iliac-SMA bypass using a saphenous vein graft.

Echocardiography was performed in two gruops of patients with impaired renal function excluding those with diabetic renal failure. Group A was comprised of 19 patients who had recieved hemodialysis from 1 year to 5 years, and Group B, of 32 patients who had been undergoing hemodialysis for more than 10 years. Significant reductions in left ventricular diastolic dimensions and cardiac output were found in Group B. In these two groups, there were no statistically significant differences in left ventricular wall thickness and left ventricular ejection fraction. Left ventricular diastolic function was assessd by the ratio of the peak atrial velosity (A) to early diastolic velosity (E). 15 patients (83%) in Group A and 19 patients (76%) in Group B had left ventricular diastolic dysfunction. A high incidence of left ventricular diastolic dysfunction was revealed. Moreover, dilated and hypertrophic cardiomyopathy like patterns were observed in both groups. In Group B, significantly increased left ventricular wall thickness in patients with hypertension and reduced left ventricular systolic function in patients with dialysis hypotension were found.

Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.