An 80-year-old woman presented with dilatation of the distal aortic arch due to chronic type B aortic dissection. She underwent thoracic endovascular aortic repair (TEVAR) in zone 2 with GORE TAG thoracic endoprostheses (40 mm-15 cm and 34 mm-20 cm) for closure of the entry site at the proximal descending aorta. TEVAR was successfully performed and blood flow in the false lumen stopped. Two months after TEVAR, she was admitted to our hospital owing to syncope. A CT scan revealed type A aortic dissection, and emergency surgery was performed. The entry was proximal to the stent graft, and we performed total arch replacement with preservation of the stent graft. Retrograde type A aortic dissection is a rare but lethal complication of TEVAR. Careful consideration of the device selection is needed, and attention should be paid to the placement of the stent graft.

Introduction：Although psychosocial support for cancer patients, their family, and those who are bereaved is essential, it is still considered inadequate. Anyone can become a member of the “Gan Cafe” support group, such as those suffering from cancer, those who have survived cancer, family members of cancer patients and those who have lost people to cancer, can get psychosocial support and palliative care support from palliative care unit staff. Case：A 53-year-old male was diagnosed with lung cancer in 2001 and underwent surgery. In 2006 he underwent chemotherapy, as he suffered a relapse. In 2012, while undergoing treatment, he joined the “Gan Cafe” along with his family members. He was able to interact with other members of the group and with the staff of the palliative care unit as a cancer patient, while his wife and children could interact with them as cancer patients family members. Six months later, when being admitted to the palliative care unit, the patient and his family members felt secure as they had become well acquainted with the staff at the “Gan Cafe.” After he had passed away, the wife continued to participate in the “Gan Cafe” as a bereaved family member and the same staff provided her with grief support. Conclusion：Through participation in the “Gan Cafe”, the staff of the palliative care unit was able to provide continuous palliative care with a focus on psychosocial support from the pre-hospital stage to grief support after the patients passed away.

Background: Massive rotator cuff tears (MRCTs) with subscapularis (SSC) tears cause severe shoulder dysfunction. In the present study, the influence of SSC tears on three-dimensional (3D) shoulder kinematics during scapular plane abduction in patients with MRCTs was examined. Methods: This study included 15 patients who were divided into two groups: supraspinatus (SSP) and infraspinatus (ISP) tears with SSC tear (torn SSC group: 10 shoulders) or without SSC tear (intact SSC group: 5 shoulders). Single-plane fluoroscopic images during scapular plane elevation and computed tomography (CT)-derived 3D bone models were matched to the fluoroscopic images using two-dimensional (2D)/3D registration techniques. Changes in 3D kinematic results were compared. Results: The humeral head center at the beginning of arm elevation was significantly higher in the torn SSC group than in the intact SSC group (1.8±3.4 mm vs. −1.1±1.6 mm, p<0.05). In the torn SSC group, the center of the humeral head migrated superiorly, then significantly downward at 60° arm elevation (p<0.05). In the intact SSC group, significant difference was not observed in the superior-inferior translation of the humeral head between the elevation angles. Conclusions In cases of MRCTs with a torn SSC, the center of the humeral head showed a superior translation at the initial phase of scapular plane abduction followed by inferior translation. These findings indicate the SSC muscle plays an important role in determining the dynamic stability of the glenohumeral joint in a superior-inferior direction in patients with MRCTs.