We carried out endovascular stent graft implantation in a patient aged 89 years to sealed rupture of an infrarenal abdominal aortic aneurysm. He had received left ilio-femoral bypass, femoro-femoral cross over bypass and bilateral femoro-popliteal bypass due to ASO in 1989. The infrarenal abdominal aortic aneurysm accompanied with a large hematoma was 4cm in maximum diameter and reached 4cm above the bifurcation. There was extravasation into the retroperitoneal space at the proximal aortic neck. We made a stent graft from a Z stent (30mm, 7.5cm) and straight thin-walled (0.15mm) graft (24mm). It was introduced at just below the left renal artery through a 22 F delivery sheath by the femoral cut-down approach. Following this procedure he had no leaks and the abdominal aortic aneurysm was excluded by stent graft.

Anastomotic aneurysm was diagnosed in a 77-year-old man following graft replacement of the distal aortic arch aneurysm using the inclusion method in 1991, Enhanced CT demonstrated the aneurysm of the distal anastomotic site with a maximum diameter of 5cm between the graft and the aneurysmal wall. On left thoracotomy the aneurysm was found to severely adhere to the lung, so it was difficult to dissect its adhesion and clamp the proximal aorta. The rectal temperature was cooled to 18°C with the aid of femoro-femoral bypass. We anastomosed the previous graft-end to the new graft with one side branch during simple hypothermic retrograde cerebral circulation (RCC). RCC time was 16min and the distal end was anastomosed to the descending thoracic aorta. Though it took a long time to undertake systemic cooling and rewarming, intraoperative bleeding was small and the postoperative course was satisfactory without cerebral complication.

Horseshoe kidney is an unusual abnormality occurring in 0.25% of the population. In surgery for AAA with horseshoe kidney, reconstruction of aberrant renal and preservation of renal isthmus is important. We report 3 cases of AAA with horseshoe kidney treated successfully without division of the isthmus.

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.
Design: Self-controlled and externally controlled trial.
Setting: University hospital.
Participants: Fifteen residents specializing in family medicine.
Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.
Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.
Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.
Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.

Ten athletic women (5 normal ovulatory cycles, 5 short luteal phases) and 6 non-athletic women with normal ovulatory cycles were subjected to an investigation of episodic gonadotropin secretion. In the middle follicular phase, blood samples were obtained via an indwelling venous catheter every 15 minutes for 4 hours.
Mean levels of gonadotropins in both athletic groups were lower (p<0.001) than in the control group. LH pulse frequencies in the short luteal group were significantly lower than in the control group (p<0.001) . LH pulse amplitudes were similar in all groups. FSH dynamics were the same as those for LH.
In athletic women, low mean levels and infrequent episodic secretion of gonadotropins were obvious. These data suggest that strenuous athletic activity may cause hypothalamic-pituitary insufficiency, especially that of hypothalamic origin.

Athletic women often exhibit menstrual disorders such as luteal insufficiency, oligomenorrhea and amenorrhea are often seen. It has been suggested that such disorders are related to prolactin release caused by physical activity. To investigate the mechanism by which the disorders are promoted, prolactin secretion was studied in 10 athletic women (5 with normal ovulatory periods, and 5 with short luteal periods) and 6 non-athletic controls. Blood samples were obtained during the early follicular phase of the menstrual cycle through an indwelling venous catheter at 15-minute intervals for 4 hours. The concentration of prolactin was measured by radioimmunoassay.
The mean prolactin concentration in the athletic group was lower than that in the control group (p<0.001), and pulse frequency in the athletic group was higher than that of the control group (p<0.01) . Pulse amplitude in the athletic women with short luteal periods was higher than that of those with normal ovulation. Pulse duration in the athletic women with short luteal periods was significantly longer than that of those with normal ovulation (p<0.01) .
These findings suggest that prolactin is one of the most important factors in menstrual disorders in athletic women.

Congenital heart disease of partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly was very rare. 21-year-old man, who was pointed out heart disease 6 months ago, was diagnosed as partial anomalous pulmonary venous drainage of entire left lung without other cardiac anomaly by cardiac catheterization and angiography. The patient underwent surgery through the left forth intercostal incision without cardiopulmonary bypass. The end-to-side anastomosis was made between the vertical vein and the left atrial appendage following ligation of the vertical vein near the innominate vein. Surgical treatment was satisfactory in the postoperative angiography which was shown widely patent anastomosis. He was discharged with uneventful postoperative course and returned to full activity.

We report two cases of retroperitoneal fibrosis that emerged during a clinical course of moderate chronic kidney disease. In both cases, we observed an elevation in the serum CRP and IgG4 levels without an increase in the white blood cell count. The patients were treated with prednisolone. Their clinical conditions improved with a decrease in the serum IgG4 to total IgG ratio. The present cases suggest the importance of a differential diagnosis of retroperitoneal fibrosis in the medical care of chronic kidney disease patients, and we propose a useful biomarker for retroperitoneal fibrosis, which we suspect is associated with IgG4-related disease.

BACKGROUND: To examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan. METHODS: This study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children's Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster. RESULTS: Women in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03-1.87) to 1.92 (95% CI, 1.42-2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18-2.38) to 2.19 (95% CI, 1.60-2.99). CONCLUSIONS The lack of pre-disaster data in the Japan Environment and Children's Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.
Adolescent ; Adult ; Disasters ; Earthquakes ; Female ; Humans ; Japan/epidemiology* ; Pregnancy ; Pregnancy Complications/psychology* ; Pregnant Women/psychology* ; Prevalence ; Psychological Distress ; Tsunamis ; Young Adult